Transoral Laser Microsurgery in Recurrent Laryngeal Cancer: A Systematic Review and Meta‐analysis

• Published in: The Laryngoscope 2023-06, Vol.133 (6), p.1425-1433
• Main Authors: Russo, Elena, Costantino, Andrea, Veneroni, Maria Vittoria, Festa, Bianca Maria, Pellini, Raul, Campo, Flaminia, Petruzzi, Gerardo, Spriano, Giuseppe, Mercante, Giuseppe, De Virgilio, Armando
• Format: Article
• Language: English
• Subjects: Adult; Glottis - surgery; Humans; Laryngeal cancer; Laryngeal Neoplasms - pathology; Laryngoscopy; Laser Therapy; Lasers; local control; Meta-analysis; Microsurgery; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; recurrent laryngeal carcinoma; Retrospective Studies; salvage surgery; survival; transoral laser microsurgery; Treatment Outcome
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.30332

Objective To determine the oncological outcomes of salvage transoral laser microsurgery (TLM) in the treatment of patients suffering from recurrent laryngeal cancer. Methods PubMed/MEDLINE, Cochrane Library, and Scopus databases were searched. English language, original studies investigating oncological outcomes of TLM in adult patients with recurrent laryngeal cancer were included. Data were pooled using a distribution‐free approach for estimating summary local control (LC), disease‐specific survival (DSS), and overall survival (OS) curves with random effects. Results Two hundred and thirty‐five patients underwent salvage TLM after primary (chemo)radiotherapy. The mean follow‐up time was 60.8 months (95% CI: 32.7–88.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 74.2% (61.7–89.4), 53.9% (38.5–75.3), and 39.1% (25.2–60.8). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 88.4% (82.0–95.3), 67.8% (50.9–90.3), and 58.9% (42.7–81.1). Two hundred and seventy‐one patients underwent TLM after primary laser treatment. The mean follow‐up time was 70.9 months (95% CI: 36.9–104.9). Estimated pooled LC rates (95% CI) at 1, 3 and 5 years were 72.2% (64.7–80.6), 53.2% (42.2–66.9), and 40.4% (29.6–55.2). Estimated pooled DSS rates (95% CI) at 1, 3 and 5 years were 92.1% (85.5–99.1), 77.0% (64.4–92.0), and 67.1% (51.6–87.3). Conclusions TLM is a valuable treatment option for the management of locally recurrent laryngeal carcinoma if performed by experienced surgeons and following rigorous patients' selection criteria. Further studies should be conducted to define stage‐based clinical guidelines. Level of Evidence NA Laryngoscope, 133:1425–1433, 2023 The aim of this systematic review and meta‐analysis was to determine the oncological outcomes of salvage transoral laser microsurgery (TLM) in the treatment of patients suffering from recurrent laryngeal cancer. We demonstrated that TLM is a valuable treatment option for the management of locally recurrent laryngeal carcinoma if performed by experienced surgeons and following rigorous patients' selection criteria. Further studies should be conducted to define stage‐based clinical guidelines.